Psychology, 2018, 9, 372-384

http://www.scirp.org/journal/psych
ISSN Online: 2152-7199
ISSN Print: 2152-7180

Applying Positive Psychology Principles to

Soccer Interventions for People with Mental
Health Difficulties

Bettina Friedrich1, Oliver J. Mason1,2

Department of Clinical, Educational and Health Psychology, University College London, London, UK
1

School of Psychology, University of Surrey, Surrey, UK

2

How to cite this paper: Friedrich, B., & Abstract

Mason, O. J. (2018). Applying Positive
Psychology Principles to Soccer Interven-
tions for People with Mental Health Diffi-
culties. Psychology, 9, 372-384.
https://doi.org/10.4236/psych.2018.93023
Received: December 15, 2017
Accepted: March 25, 2018
Published: March 28, 2018
Copyright © 2018 by authors and
Scientific Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
Adjunct exercise interventions for people with mental health difficulties have
been shown to improve well-being while also increasing physical and social
health. Soccer as a team sport is a particularly apt form of group-based exer-
cise as it fosters social inclusion and communication skills potentially also
across cultural and socio-economic barriers. We discuss how some exercise
interventions such as those using soccer are potentially well-aligned with
concepts from Positive Psychology such as Seligman’s five elements (PERMA)
that determine “Eudaimonia” (a good life): Positive emotions (P), Engage-
ment and Flow (E), Positive Relationships (R), Meaning (M), and Accom-
plishment (A). In the present study the perceived life improvements reported
by participants of a London-based soccer intervention “Coping Through
Football” (CTF) are analysed for content using these five elements. All but
Meaning (M) could be identified clearly; Positive Relationship (R) and Ac-
complishment (A) were the most commonly reported components. The
PERMA model offers a potentially highly relevant framework to measure
changes in well-being in participants of adjunct physical exercise treatments
in mental health. Further quantitative and qualitative evaluation using the
PERMA categories has the clear potential to inform policy and funding decisions
in the growing area of psychosocial interventions in public mental health.

Keywords
Football, Soccer, Mental Health, Positive Psychology, Exercise

1. Introduction
Exercise interventions for people with mental health difficulties are very diverse

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 B. Friedrich, O. J. Mason

(see Callaghan, 2004; Mason & Holt, 2012a; Stathopoulou, Powers, Berry,
Smits, & Otto, 2006 for reviews) but include many that are aligned with the te-
nets of Positive Psychology as they focus on physical and mental well-being, so-
cial connectedness and community ties. While physical health is often a key ob-
jective, the importance of these interventions extends to psychological and social
health. Physical exercise interventions have proven to be effective for partici-
pants with anxiety (Asmundson et al., 2013), schizophrenia (Faulkner & Sparkes,
1999) and for the improvement of general mood (Barton, Griffin, & Pretty,
2012). Fenton et al. (2017) have shown that the fostering of inclusion is a main
mechanism by which exercise interventions contribute to increased well-being
for people with mental health problems; this is not surprising as they often deal
with issues of isolation (Brophy & Harvey, 2011). Mason & Holt (2012a) provide
an interesting overview of outcomes of qualitative studies on physical activity
interventions for people with mental health problems. Team sports may be par-
ticularly effective in enhancing psychosocial health through inclusion (Barber et
al., 2001; Eime, Young, Harvey, Charity, & Payne, 2013) and the positive direct
impact of team sports on adolescent mental health has been shown by Steiner,
McQuivey, Pavelski, Pitts, & Kraemer (2000).
Among different team sports, soccer seems to hold a particular potential for
increasing psychosocial health with a broad appeal to males in cultures that
highly valorize this sport at least. Friedrich & Mason (2017) provide an overview
of the peer-reviewed literature on the effectiveness of soccer interventions for
people with mental health problems. Evidence shows that these interventions are
effective in increasing physical and mental well-being on a range of outcome
measures and for a variety of target groups. Darongkamas et al. (2011) for ex-
ample show in a mixed method study on men with mental health issues who
took part in a soccer intervention, that participation improved mental health
symptoms as well as attitudes about themselves, and general well. Carter-Morris
& Faulkner (2003) found that male service users experienced the soccer inter-
vention as a meaningful opportunity for social interaction and those participants
who were dealing with schizophrenia reported that participation challenged au-
ditory hallucinations and delusional beliefs. Furthermore, Steckley (2005) showed
in an observational study that soccer interventions improved inclusion, resi-
lience and empowerment in boys is residential care who experience emotional
and behavioral difficulties. Mason & Holt (2012b) identified in a qualitative stu-
dies themes of recovery such as identifying with past self; service with a differ-
ence: opening up the social world; safety; empowerment; and feeling good. In a
very recent study that used focus groups with participants, Lamont et al. (2017)
have shown that participants in a walking football intervention in Scotland re-
ported relational, personal and physical recovery-related benefits. Furthermore,
soccer interventions could be shown to improve fitness (McElroy et al., 2008),
general physical activity (Friedrich & Mason, 2018), and physical fitness (O’Kane
& McKenna, 2002).

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B. Friedrich, O. J. Mason

1.1. PERMA-Model: The Essential Elements of Well-Being

In his book “Flourish”, Seligman (2012) introduces a theory of human well-being
as a multi-factorial construct. He states that “… no single measure defines it ex-
haustively (…), but several things contribute to it; these are the elements of
well-being, and each of the elements is a measurable thing” (p. 15). According to
Seligman, there are five elements that define well-being: Positive emotions (P),
Engagement and Flow (E), Positive Relationships (R), Meaning (M), and Ac-
complishment (A). For a detailed description of these elements, see Seligman
(2012: pp. 16-21). Seligman argues that these elements are defined by three
properties: Firstly, they contribute to well-being. Secondly, they are pursued for
their own sake and not with the purpose of gaining another element; and finally
they are measured and defined independently of other elements.
Central to the theory is the assumption that true fulfilment (sometimes called
“eudemonia”) goes beyond mere pleasure, but also involves experienced mea-
ningfulness and accomplishment. In their paper “Using well-being for public
policy: Theory, measurement, and recommendations” Adler & Seligman (2016:
p. 5) state it thus: “Whereas hedonic well-being emphasizes the importance of
feeling good, eudemonic well-being is characterized by functioning well in mul-
tiple domains of life”. Hence an important and innovative implication of this
model is that well-being cannot be measured along one single dimension, but
rather that it is multi-dimensional, as true well-being is an experience that re-
quires the satisfaction of a number of needs.
What contribution could this model make with regard to the evaluation (and
application) of mental health interventions? By defining the key ingredients of
true well-being, the model can help guide the development of interventions beyond
mere symptom reduction. By operationalizing the components of well-being,
these concepts may inform evaluation. In a comprehensive review Fenton et al.
(2017: p. 12) concluded that “Both the recovery model and the tenets of positive
psychology could be used more explicitly as theoretical frameworks to guide
contemporary research regarding the potential of community-based recreation
to influence recovery and social inclusion”. A well-articulated and operationa-
lized definition of well-being helps evaluation move beyond rather binary suc-
cess/fail judgments by elucidating the relative strengths and weaknesses of an
intervention’s effects on the different key well-being dimensions. This informa-
tion can be used to help improve and tailor intervention delivery to maximize
benefits. However, empirical research explicitly using this model is limited to
date. The following section examines how some of the findings of soccer-based
interventions can be viewed within the PERMA model.

1.2. Soccer Interventions through the PERMA Lens

Soccer interventions as an adjunct treatment form to help people with mental
health problems have a growing popularity (Friedrich & Mason, 2017). A note-
worthy feature of these interventions is their ability to benefit participants in a

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 B. Friedrich, O. J. Mason

variety of ways. Most obviously there are physical health benefits (for a compar-
ison of physical health benefits for different sports disciplines see Oja et al.,
2015). Osborn (2001) has pointed out the need for improving physical health in
people with psychiatric problems because of their high morbidity and the mor-
tality rate. Studies have shown links between cardiovascular diseases and schi-
zophrenia (Ringen, Engh, Birkenaes, Dieset, & Andreassen, 2014) as well as with
depression (Hare, Toukhsati, Johansson, & Jaarsma, 2013), so the positive im-
pact of soccer on cardiovascular function is very important (Krustrup et al.,
2013; Krustrup et al., 2014). Boehm & Kubzansky (2012) offer an interesting
view on cardiovascular health, well-being and health behavior from a Positive
Psychology perspective.
The benefits of soccer interventions go beyond physical health benefits. Due
to its nature as team sports, soccer provides opportunity for social inclusion and
can strengthen and rehabilitate social skills (Battaglia et al., 2013; Nielsen et al.,
2014). A particular advantage of soccer interventions seems to be its attractive-
ness for people (especially men) across different ethnic and socio-demographic
backgrounds (Mellor, 2008; Parnell & Richardson, 2014). Yet another advantage
is the relatively low costs and organizational demands of the activity. For these
reasons, soccer has experienced a growing interest as intervention form, includ-
ing in a therapeutic context; see for example Steckley (2005). Mutrie & Faulkner
(2004) made a very strong case for using Positive Psychology principles in exer-
cise interventions for people with mental health problems concluding “we be-
lieve that physical activity participation epitomizes the principles of positive
psychology” (p. 22). Lambert, D’Cruz, Schlatter, & Barron (2016) took a similar
stance and spoke out in favor of implementing the Positive Psychology approach
for physical interventions in order to treat and prevent depression. Parschau et
al. (2014) used the Positive Psychology approach to investigate the mechanisms
in which physical exercise operate and conclude that experienced self-efficacy
during exercise contributes largely to the positive experience and results in mo-
tivation for continuation of physical activity. Most recently, Van Cappellen,
Rice, Catalino, & Fredrickson (2017) have demonstrated the significance of posi-
tive affective processes during health related behavior in facilitating long-lasting
positive health behavior change.
Many soccer interventions explicitly tackle several aspects of physical, psy-
chological and social health that can be interpreted in terms of the PERMA ele-
ments (given in parentheses by ourselves). For example, a qualitative evaluation
(Brawn, Combes, & Ellis 2015) of the “Mental health and football well-being
league” in the Northwest of England, suggested improvements across a range of
elements in the participants: physical and psychological well-being (Enjoyment),
sense of belonging (Positive Relationship), sense of achievement (Accomplish-
ment) among others. Magee, Spaaij, & Jeanes (2015) reported connectedness
(Positive Relationship), counteracting stigma (Meaning), sense of safety (En-
joyment). As a last example, Butterly, Adams, Brown, & Golby (2006) showed

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B. Friedrich, O. J. Mason

that a community based physical activity project including soccer led to the en-
joyment of exercise (Enjoyment), increased self-confidence (Accomplishment),
participants reported making more friends (Positive Relationship), participants
planned educational and vocational qualifications (Meaning) and weight loss
positively affected their self-esteem (Accomplishment). In addition to the spec-
trum of PERMA-relevant outcomes, even this short set of examples illustrates
that different projects emphasize different components: one central issue for de-
bate is whether competitiveness (Achievement) or team spirit (Positive Rela-
tions) should be emphasized (see for example Steckley, 2005). Similarly, partici-
pants often have varied expectations and experiences as to the benefits—some
might be interested in improving their fitness and skills (Achievement), others
might be more interested in the company, the sense of belonging (Positive Rela-
tionships) and the fun (Enjoyment). In conclusion, soccer interventions proba-
bly target many if not all of the PERMA-defined components of well-being, and
have often proposed very similar themes to the elements of the model.

1.3. The Intervention: Coping through Football (CTF)

Coping Through Football (CTF) is a soccer scheme that has been developed as
an adjunct treatment for people with mental health problems who are receiving
secondary mental health treatment. This intervention is a collaboration between
the London Playing Fields Foundation, the North East London Health Trust
(NELFT) and the football club Leyton Orient. Participants attend informal soc-
cer sessions regularly to improve their physical fitness and well-being, and to
have the opportunity to socialize with other participants. Furthermore, healthy
living workshops are organized as well as other social events such as soccer
tournaments. Occupational therapists attend the sessions and monitor physical
and emotional well-being of participants regularly; furthermore, they discuss ex-
it routes and outcomes of the intervention with the participants and monitor
their respective progress. This information is usually gathered at the start of the
intervention and then collected bi-annually. Mason & Holt (2012b) have pre-
viously carried out a qualitative evaluation of the intervention, and Friedrich &
Mason (2017) have reported quantitative outcomes. In this study we analyze
further responses obtained from routine monitoring since 2012.

2. Methods
Between 2012-2017, 329 people (309 male, 97%) participated in the Coping
Through Football intervention. Participation was in principle open to anybody
using the mental health services of the local NHS trust (NELFT)-health workers
referred patients to the service when the soccer intervention seemed suitable and
promising for their recovery. Attendance was completely voluntary and partici-
pants had the right to drop out any point without it affecting any other health
services they are receiving through NELFT. The average age of the participants
at the start date was 30.6 years (SD = 10.08). The ethnic breakdown of this group

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 B. Friedrich, O. J. Mason

is as follows: 122 white (37%), 98 black (30%), 59 Asian (18%), 22 mixed (7%),
15 other (5%) and 13 unknown (4%). Participants are asked to describe any
changes noticed as a result of attendance at reviews that occur every six months
(verbatim of the question: “What improvements to your life do you feel could be
gained by taking part in the Coping Through Football Scheme?”). We included
information on life improvement for participants who have been regularly at-
tending the intervention over a period of at least one year and whose data was
subsequently available for at least two time points. The number of times partici-
pants were reviewed depended on their length of participation at CTF; during
some reviews these qualitative answers were not collected for pragmatic reasons
such as time constraints. For the participants who could be included in this
study, respective data on subjective life improvements was available on average
from 2 - 3 reviews. Data was always taken from the most recent time point,
leading to responses for 86 participants (78 male, 91%). Average age of these
participants was 30.11 years (SD = 8.586). The ethnic breakdown of this group
was 34 white (40%), 27 black (31%), 13 Asian (15%), 11 mixed (13%), and 1 un-
known (1%). Demographically, respondents were highly similar to attenders of
the intervention as a whole. The breakdown of diagnoses was as follows: 36 par-
ticipants had a psychosis (42%), 25 emotional disorder(s) (29%), 13 reported
having drug and alcohol issues as main problem (15%), 3 reported having a per-
sonality disorder (3%), two participants had neurodevelopmental disorders
(2%); for 7 participants (8%) the exact diagnoses was not known.
A content analysis was performed to classify statements according to the
PERMA elements as defined by Seligman (2012)—the description of his model
provided the coding system consisting of the five PERMA elements. The two
authors reached an agreement as to how the PERMA elements were exactly to be
interpreted and how the statements were to be assigned to these categories in the
content analysis. The first coder conducted the content analysis and this was the
thoroughly cross-checked by the second author. The categorization system was
almost fully exhaustive-out of the 86 answers only one could not be assorted to a
PERMA element, as practically all responses were related to one or more ele-
ments of well-being. The content analysis was carried out in close collaborations
between the two authors. One author (BF) coded the statements which were
then critically evaluated by the second author (OM). As the PERMA model
clearly defines their elements, the assignments of the statements to categories
used these definitions very explicitly and closely. When in doubt as to whether
the item would truly fit into an element, a conservative approach was taken and
the content was excluded. Some statements were assigned to more than just one
category as their content applied to several elements of well-being.

3. Results
98.8% of statements could be categorized using the coding scheme with 75.6%
assigned to two or more categories. The categories are reported below in order of
decreasing frequency.

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B. Friedrich, O. J. Mason

3.1. Positive Relationship (R)

The most commonly mentioned element was “Positive Relationship (R)”: 58 out
of 86 (67%) gave responses that indicated that they felt participation led to posi-
tive relationship experiences. Interestingly not only positive relationships
formed in the intervention sessions were mentioned (“coming to CTF has im-
proved my life. I have made new friends only because I come here to CTF”;
“CTF has provided me with opportunity to meet others that have experienced
similar distressed”), but also relationships with people outside of the interven-
tion (“I get on… much better with my family, my brother and we understand
each other much better”). As evident from the last statement and the several
other statements on positive relationships, the experience to connect to others
was often interpreted by participants as indicative of improved communication
skills and is therefore also experienced as an accomplishment. For some, in-
creased self-esteem was also a part of this change (“CTF has improved my
self-esteem—I have become more sociable and improved my interpersonal
skills.”). Additionally, relationship experiences seem to encourage some partici-
pants to reflect on own emotional competence (“Being with people. Need to
think about what makes me angry. Need to think about dealing with anger”,
“Being around others in a social environment, semi-competitive environment is
quite challenging—I am developing self-awareness”). Moreover, it helped com-
batting loneliness (“[I] feel less lonely and [I am] going out”) and building a so-
cial support network (“My friends here have helped me out when I have had
some troubles”). Furthermore, well-being was socially “infectious”, perhaps
pointing to a virtuous cycle (“I get happiness from seeing others happy”).
The frequency and centrality of R-related statements underline the impor-
tance of the interpersonal side of team sports like soccer, and the positive impact
of social contact very broadly (“going out, feeling better about myself”). Rela-
tionships were sustained outside of the intervention (“We chat on the phone
between sessions”).

3.2. Achievement (A)

The Achievement (A) element occurred second mostly commonly in 54 of 86
(63%) responses. These accomplishments ranged from dealing with personal
symptoms (“I was able to learn coping strategies and use them to overcome de-
pressing and suicidal thoughts”); lifestyle choices (“[I] reduce the amount of
junk food I eat—I am eating more fruit and veg”); living arrangements (“[I] was
in secure hospital when I came to CTF, then I moved to support, now I am in
independent flat”); improvements in personal interaction/relationships as men-
tioned above (“it has helped me with my confidence, made friends, engaging
with a social life”); and achievements that were activity related (“I do feel good
when I shoot a goal”, “[CTF] made me feel more energetic [and] helped improve
fitness”).

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 B. Friedrich, O. J. Mason

3.3. Engagement (E)

Almost half the participants (40, 47%) reflected having benefitted from being
able to engage in an activity in which they found satisfaction. As the respective
statements often implied that they enjoyed the activity, these statements also
contributed to “Positive Emotions (P)”. Participants intrinsically appreciated
engaging in the activity of playing soccer (“I like to play soccer for fun”, “enjoy-
ment of kicking the ball at CTF”) and also commented on how the increase of
fitness enhanced the enjoyment of this activity (“I get to enjoy playing fb more”,
“it [soccer] is something I love and I have got a natural talent”). Since many par-
ticipants seem to have a very limited range of regular activities as a results of
their mental health problem, the provision of an activity in which they could
engage with is key (“it gets me out of the ward”, “[CTF is] somewhere to go”, “I
wasn’t doing much before CTF”), and has let to general activity (“[I] have been
going out more”), in particular engagements in other sports (“interested in gym,
mixed martial arts”). It seems CTF has provided in some cases an exit route
from a more sedentary, passive lifestyle and also provided structure (“[CTF]
added structure”).

3.4. Positive Emotions (P)

A similar number of participants (38, 44%) reported Positive Feelings (P). These
were often expressed in connection with statements that touched on other ele-
ments of the PERMA model, for example when participants expressed pleasure
of playing soccer and exercising (“enjoy soccer, scoring more goals”, “getting a
buzz from exercise”, “I like the game, enjoy the match, I see my friends have a
laugh”), the joy they get out of achievement (“My fitness has improved. I like
scoring goals”; “Scoring goals—especially one, two [goals], involving two play-
ers”) and the excitement of socializing with others (“I enjoy talking to the lads”,
“Meeting new people, new comers, forget my worries, makes me feel positive”).
Hence the majority of these statements were also coding under other categories.
General enjoyment was reported (“[I] feel alive when I am at CTF”; “I relax, no
stress”, “challenging energy, endorphin release”; “CTF increases my well-being”),
as well as reduced negative emotional states that might be associated with the
mental health related symptoms (“Less anxious”, “I feel no different to others. I
am more myself, I am sure of myself. I am not angry”). Furthermore, over time a
strengthened ability to feel enjoyment was perceived (“I enjoy soccer more”).

3.5. Meaning (M)

Of all elements of the PERMA model, Meaning (M) was the one to which it was
hardest to assigns comments to with a reasonable degree of certainty. The expe-
rience of a meaningful experience was not explicitly described but could some-
times indirectly be derived from the statements regarding life improvements.
Due to the lack of certainty however, this category was felt too ambiguous to use
in the present study. This may be a result of the very brief nature of feedback al-

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B. Friedrich, O. J. Mason

lowed. More in-depth analysis of longer qualitative interviews might reveal more
insight into the perceived meaningfulness of the intervention.

4. Discussion
Despite some limitations discussed below, the PERMA model was very largely
suitable for classifying reported life improvements in a meaningful and reasona-
bly comprehensive manner for all statements relating to well-being. The fact that
almost all statements could be categorized suggests a good fit between the con-
tent and the PERMA elements.
It is important to note that this project is an adjunct treatment intervention,
with all participants having received secondary mental health care. This inter-
vention is not intended nor designed to replace formal mental health treatment.
Rather, it aims to add to the general well-being and resilience of the participants
by providing a rewarding activity in a social context: the self-reported benefits of
the intervention appear to be strongly consistent with the Positive Psychology
approach—as defined in Seligman’s well-being theory and respective PERMA
model. The Coping Through Football intervention, in common with several
soccer interventions, is explicitly aimed at increasing social inclusion: a psy-
chosocial outcome indexed most closely by the Positive Relationship category.
Thus it is encouraging that this was the most frequently endorsed life improve-
ment by two-thirds of respondents. However, perceived improvements extended
beyond this to encompass all but one of the PERMA categories. This is very en-
couraging for community public health interventions using sport/physical activ-
ity to engage users of mental health services.
A very large proportion of the perceived life improvements could be classified
within the PERMA categories. Although not offering comprehensive coverage,
the model provided a very useful framework for summarizing, re-presenting
outcomes for a physical activity intervention in a mental health setting. The rela-
tive absence of Meaning statements could be due to the very brief nature of
questioning here. Alternatively, Heintzelman & King’s (2014) have outlined sev-
eral problems with the assumption that the pursuit of meaning is worthwhile for
the individual. Category-based classification enabled a degree of quantification
that, in another context, might have enabled analysis by demographics or other
characteristics of the participants.
A further limitation is that the reported life improvements were not obtained
in extensive in-depth qualitative interviews but rather from short answers col-
lected in the context of regular health and well-being monitoring. For this rea-
son, it is unlikely to be comprehensive in scope or depth, but instead captures
the subjective, personal life improvement “highlights” prioritized by partici-
pants. Assigning content to the PERMA categories was necessarily somewhat
subjective and the “Meaning (M)” element could not be reliably identified in the
responses. Many statements could be, and indeed were, assigned to more than
one PERMA element, as they reflected life improvements that touched on dif-

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 B. Friedrich, O. J. Mason

ferent well-being components.

A recent review of the current literature on adjunct soccer interventions for
people with mental health problems (Friedrich & Mason, 2017) reported that
most evaluations studies on soccer interventions use qualitative methods, with a
relative dearth of quantitative evaluation studies. In part this may be due to a
perceived lack of suitable outcome measures. Similar to Eime’s approach (Eime
et al., 2013), quantitative data pertaining to well-being could be used to develop
measures tailored for physical activity. The PERMA model offers a sound basis
for such a tool to measure impact in terms of its components of well-being.
The current study adds to the empirical evidence suggesting that soccer inter-
ventions show great potential as an effective adjunct intervention for people with
mental health problems. Based on the present data, we are not able to draw reli-
able conclusions on the potential of other highly interactive team sports such as
basketball for example to foster well-being as defined in the PERMA-model, but
nothing speaks against the assumption that similar effects in fostering well-being
in people with mental health problems might be found. Respective evaluation
work could bring more light to this question. Greater evidence can help inform
policy makers and potential funders as to approaches deserving of wider imple-
mentation alongside conventional medical and other treatment modalities. Posi-
tive Psychology offers an excellent framework in order to reshape conventional
thinking in mental health.

5. Conclusion
In conclusion we believe that the aims of soccer interventions as adjunct treat-
ment from are well aligned with principles and aims of the Positive Psychology
approach. The outcomes of this study suggest that respective framework and
methodology can be used to develop, implement and evaluate such interven-
tions. Data for this study was limited both in the sense of number participants
who provided information on subjective life improvements as well as the com-
prehensiveness of the available answers. Future evaluations might be able to use
the Positive Psychology approach even more effectively by emphasizing qualita-
tive data collection along the PERMA elements and allowing for more in depth
responses. This might also provide more useful data with respect to the per-
ceived meaningfulness of the intervention. The present study suggests that there
is a great potential in using Positive Psychology as a framework for understand-
ing mechanisms and effectiveness of soccer interventions, and possible of sports
interventions in general.

Acknowledgements
This research was funded by the NIHR School for Public Health Research
(SPHR) Public Health Practice Evaluation Scheme (PHPES). The views ex-
pressed are those of the author(s) and not necessarily those of the NHS, the
NIHR or the Department of Health. The NIHR School for Public Health Re-

DOI: 10.4236/psych.2018.93023 381 Psychology

B. Friedrich, O. J. Mason

search (SPHR) is a partnership between the Universities of Sheffield, Bristol,

Cambridge, Imperial College London, UCL; The London School for Hygiene
and Tropical Medicine; the LiLaC collaboration between the Universities of Li-
verpool and Lancaster and Fuse; The Centre for Translational Research in Public
Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland
and Teesside Universities. Grant holder is Dr Oliver Mason. We thank the staff
and participants of the intervention, and particularly Sonia Smith, Andrea
Shepherd and Barbara Armstrong for their invaluable role in its evaluation.

References
Adler, A., & Seligman, M. E. (2016). Using Well-Being for Public Policy: Theory, Mea-
surement, and Recommendations. International Journal of Well-being, 6, 1-35.
https://doi.org/10.5502/ijw.v6i1.429
Asmundson, G. J., Fetzner, M. G., DeBoer, L. B., Powers, M. B., Otto, M. W., & Smits, J.
A. (2013). Let’s get Physical: A Contemporary Review of the Anxiolytic Effects of Exer-
cise for Anxiety and Its Disorders. Depression and Anxiety, 30, 362-373.
https://doi.org/10.1002/da.22043
Barber, B. L., Eccles, J. S., & Stone, M. R. (2001). Whatever Happened to the Jock, the
Brain, and the Princess? Young Adult Pathways Linked to Adolescent Activity In-
volvement and Social Identity. Journal of Adolescent Research, 16, 429-455.
https://doi.org/10.1177/0743558401165002
Barton, J., Griffin, M., & Pretty, J. (2012). Exercise-, Nature- and Socially Interac-
tive-Based Initiatives Improve Mood and Self-Esteem in the Clinical Population. Pers-
pectives in Public Health, 132, 89-96. https://doi.org/10.1177/1757913910393862
Battaglia, G., Alesi, M., Inguglia, M., Roccella, M., Caramazza, G., Bellafiore, M., & Palma,
A. (2013). Soccer Practice as an Add-On Treatment in the Management of Individuals
with a Diagnosis of Schizophrenia. Neuropsychiatric Disease and Treatment, 9,
595-603. https://doi.org/10.2147/NDT.S44066
Boehm, J. K., & Kubzansky, L. D. (2012). The Heart’s Content: The Association between
Positive Psychological Well-Being and Cardiovascular Health. Psychological Bulletin,
138, 655-691. https://doi.org/10.1037/a0027448
Brawn, P., Combes, H., & Ellis, N. (2015). Football Narratives: Recovery and Mental
Health. The Journal of New Writing in Health and Social Care, 2, 30-46.
Brophy, L., & Harvey, C. (2011). Social Isolation in People with Mental Illness. Medicine
Today, 12, 73-78.
Butterly, R., Adams, D., Brown, A., & Golby, J. (2006). Client Perceptions of the
MUSCSEL Project: A Community-Based Physical Activity Programme for Patients
with Mental Health Problems. Journal of Public Mental Health, 5, 45-52.
https://doi.org/10.1108/17465729200600031
Callaghan, P. (2004). Exercise: A Neglected Intervention in Mental Health Care? Journal
of Psychiatric and Mental Health Nursing, 11, 476-483.
Carter-Morris, P., & Faulkner, G. (2003). A Football Project for Service Users: The Role
of Football in Reducing Social Exclusion. Journal of Mental Health Promotion, 2,
24-30.
Darongkamas, J., Scott, H., & Taylor, E. (2011). Kick-Starting Men’s Mental Health: An
Evaluation of the Effect of Playing Football on Mental Health Service Users’
Well-Being. International Journal of Mental Health Promotion, 13, 14-21.

DOI: 10.4236/psych.2018.93023 382 Psychology

 B. Friedrich, O. J. Mason

https://doi.org/10.1080/14623730.2011.9715658
Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., & Payne, W. R. (2013). A Syste-
matic Review of the Psychological and Social Benefits of Participation in Sport for
Children and Adolescents: Informing Development of a Conceptual Model of Health
through Sport. International Journal of Behavioral Nutrition and Physical Activity, 10,
98.
Faulkner, G., & Sparkes, A. (1999). Exercise as Therapy for Schizophrenia: An Ethno-
graphic Study. Journal of Sport and Exercise Psychology, 21, 52-69.
https://doi.org/10.1123/jsep.21.1.52
Fenton, L., White, C., Gallant, K. A., Gilbert, R., Hutchinson, S., Hamilton-Hinch, B., &
Lauckner, H. (2017). The Benefits of Recreation for the Recovery and Social Inclusion
of Individuals with Mental Illness: An Integrative Review. Leisure Sciences, 39, 1-19.
https://doi.org/10.1080/01490400.2015.1120168
Friedrich, B., & Mason, O. J. (2017). “What Is the Score?” A Review of Football-Based
Public Mental Health Interventions. Journal of Public Mental Health, 16, 144-158.
https://doi.org/10.1108/JPMH-03-2017-0011
Friedrich, B., & Mason, O. J. (2018). Evaluation of the Coping through Football Project:
Physical Activity and Psychosocial Outcomes. The Open Public Health Journal, 10,
276-282.
Hare, D. L., Toukhsati, S. R., Johansson, P., & Jaarsma, T. (2013). Depression and Cardi-
ovascular Disease: A Clinical Review. European Heart Journal, 35, 1365-1372.
https://doi.org/10.1093/eurheartj/eht462
Heintzelman, S. J., & King, L. A. (2014). Life Is Pretty Meaningful. American Psycholo-
gist, 69, 561-574. https://doi.org/10.1037/a0035049
Krustrup, P., Hansen, P. R., Nielsen, C. M., Larsen, M. N., Randers, M. B., Manniche, V.
et al. (2014). Structural and Functional Cardiac Adaptations to a 10-Week
School-Based Football Intervention for 9-10 Year-Old Children. Scandinavian Journal
of Medicine & Science in Sports, 24, 4-9. https://doi.org/10.1111/sms.12277
Krustrup, P., Randers, M. B., Andersen, L. J., Jackman, S. R., Bangsbo, J., & Hansen, P. R.
(2013). Soccer Improves Fitness and Attenuates Cardiovascular Risk Factors in Hyper-
tensive Men. Medicine and Science in Sports and Exercise, 45, 553-560.
https://doi.org/10.1249/MSS.0b013e3182777051
Lambert, L., D’Cruz, A., Schlatter, M., & Barron, F. (2016). Using Physical Activity to
Tackle Depression: The Neglected Positive Psychology Intervention. Middle East Jour-
nal of Positive Psychology, 2, 42-60.
Lamont, E., Harris, J., McDonald, G., Kerin, T., & Dickens, G. L. (2017). Qualitative In-
vestigation of the Role of Collaborative Football and Walking Football Groups in Men-
tal Health Recovery. Mental Health and Physical Activity, 12, 116-123.
https://doi.org/10.1016/j.mhpa.2017.03.003
Magee, J., Spaaij, R., & Jeanes, R. (2015). “It’s Recovery United for Me”: Promises and
Pitfalls of Football as Part of Mental Health Recovery. Sociology of Sport Journal, 32,
357-376. https://doi.org/10.1123/ssj.2014-0149
Mason, O. J., & Holt, R. (2012a). Mental Health and Physical Activity Interventions: A
Review of the Qualitative Literature. Journal of Mental Health, 21, 274-284.
https://doi.org/10.3109/09638237.2011.648344
Mason, O. J., & Holt, R. (2012b). A Role for Football in Mental Health: The Coping
through Football Project. The Psychiatrist, 36, 290-293.
https://doi.org/10.1192/pb.bp.111.036269

DOI: 10.4236/psych.2018.93023 383 Psychology

B. Friedrich, O. J. Mason

McElroy, P., Evans, P., & Pringle, A. (2008). Sick as a Parrot or over the Moon: An Evalu-
ation of the Impact of Playing Regular Matches in a Football League on Mental Health
Service Users. Practice Development in Health Care, 7, 40-48.
https://doi.org/10.1002/pdh.245
Mellor, G. (2008). The Janus-Faced Sport: English Football, Community and the Legacy
of the “Third Way”. Soccer & Society, 9, 313-324.
https://doi.org/10.1080/14660970802008942
Mutrie, N. and Faulkner, G. (2004) Physical Activity: Positive Psychology in Motion. In
P. A. Linley, & S. Joseph (Eds.), Positive Psychology in Practice (pp. 146-164). Hobo-
ken, NJ: John Wiley & Sons, Inc. https://doi.org/10.1002/9780470939338.ch9
Nielsen, G., Wikman, J. M., Jensen, C. J., Schmidt, J. F., Gliemann, L., & Andersen, T. R.
(2014). Health Promotion: The Impact of Beliefs of Health Benefits, Social Relations
and Enjoyment on Exercise Continuation. Scandinavian Journal of Medicine & Science
in Sports, 24, 66-75. https://doi.org/10.1111/sms.12275
O’Kane, P., & McKenna, B. (2002). Five a Side Makes a Difference. Mental Health Nurs-
ing, 22, 6-9.
Oja, P., Titze, S., Kokko, S., Kujala, U. M., Heinonen, A., Kelly, P. et al. (2015). Health
Benefits of Different Sport Disciplines for Adults: Systematic Review of Observational
and Intervention Studies with Meta-Analysis. British Journal of Sports Medicine, 49,
434-440. https://doi.org/10.1136/bjsports-2014-093885
Osborn, D. P. (2001). The Poor Physical Health of People with Mental Illness. Western
Journal of Medicine, 175, 329-332. https://doi.org/10.1136/ewjm.175.5.329
Parnell, D., & Richardson, D. (2014). Introduction. Soccer & Society, 15, 823-827.
https://doi.org/10.1080/14660970.2014.920619
Parschau, L., Fleig, L., Warner, L. M., Pomp, S., Barz, M., Knoll, N. et al. (2014). Positive
Exercise Experience Facilitates Behavior Change via Self-Efficacy. Health Education &
Behavior, 41, 414-422. https://doi.org/10.1177/1090198114529132
Ringen, P. A., Engh, J. A., Birkenaes, A. B., Dieset, I., & Andreassen, O. A. (2014). In-
creased Mortality in Schizophrenia Due to Cardiovascular Disease—A Non-Systematic
Review of Epidemiology, Possible Causes, and Interventions. Frontiers in Psychiatry, 5,
137. https://doi.org/10.3389/fpsyt.2014.00137
Seligman, M. E. (2012). Flourish: A Visionary New Understanding of Happiness and
Well-Being: Simon and Schuster. New York, NY: Atria Books.
Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A., & Otto, M. W. (2006). Exercise
Interventions for Mental Health: A Quantitative and Qualitative Review. Clinical Psy-
chology: Science and Practice, 13, 179-193.
Steckley, L. (2005). Just a Game? The Therapeutic Potential of Football Facing Forward:
Residential Child Care in the 21st Century (pp. 137-147). Lyme Regis: Russell House
Publishing.
Steiner, H., McQuivey, R. W., Pavelski, R., Pitts, T., & Kraemer, H. (2000). Adolescents
and Sports: Risk or Benefit? Clinical Pediatrics, 39, 161-166.
https://doi.org/10.1177/000992280003900304
Van Cappellen, P., Rice, E. L., Catalino, L. I., & Fredrickson, B. L. (2017). Positive Affec-
tive Processes Underlie Positive Health Behaviour Change. Psychology & Health, 33,
77-97.

DOI: 10.4236/psych.2018.93023 384 Psychology